| NPI | 1760496350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 179637) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MA60701) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2021-05-27 |